<div class="bjui-pageContent tableContent">
    <form action="__URL__/lockss/navTabId/{:CONTROLLER_NAME}/va/nopass" class="pageForm" data-toggle="validate">
		<input type="hidden" name="id" value="{$id}">
        <div class="pageFormContent" data-layout-h="0">
          <table class="table table-condensed table-hover" width="100%">
           <tbody>
		   <tr ><td><input type="hidden" name="order_id" value="{$order_id}"></td></tr>
		   <tr ><td><input type="hidden" name="uid" value="{$uid}"></td></tr>
		   <tr ><td><input type="hidden" name="login_id" value="{$login_id}"></td></tr>
       <tr><td><input type="hidden" name="suffit" value="{$suffit}"></td></tr>
       <tr>
		      <td><textarea name="reason" cols="80" rows="10"></textarea></td>
		   </tr>
       <tr><td><input type="radio" name="credit" value="7"/>7天</td></tr>
           </tbody>
          </table>
        </div>
    </form>
</div>
<div class="bjui-pageFooter">
    <ul>
       <li><button type="button" class="btn-close" data-icon="close">取消</button></li>
       <li><button type="submit" class="btn-default" data-icon="save">保存</button></li>
    </ul>
</div>